---
title: "POST /api/claim/professional/v1"
method: POST
path: "/api/claim/professional/v1"
---

# POST /api/claim/professional/v1

`POST /api/claim/professional/v1`

Creates a professional claim from a CMS 1500 file. This schema is an augmentation of the Healthie CMS 1500 schema to support the full CMS-1500 claim format.

## Query parameters

- `attachmentId` string
- `primaryPcn` string

## Request body

- object
  - `accept_assignment` boolean, required — Whether the provider agrees to accept assignment
  - `id` string, required — Unique identifier for the CMS 1500 form
  - `date_of_service` string, required — Date when the service was provided
  - `total_charge` string, required — Total charge amount for the claim
  - `patient` object, required — Information about the patient
    - `id` string — Patient identifier
    - `first_name` string — Patient's first name
    - `last_name` string — Patient's last name
    - `name` string — Patient's full name
    - `gender` string — Patient's gender
    - `dob` string — Patient's date of birth
    - `location` object — Patient's address information
      - `city` string — City
      - `country` string — Country
      - `line1` string — Address line 1
      - `line2` string — Address line 2
      - `name` string — Location name
      - `state` string — State
      - `to_oneline` string — Single line address representation
      - `zip` string — ZIP/Postal code
      - `place_of_service` object — Place of service details
        - `code` string — Code of the place of service
        - `name` string — Name of the place of service
        - `code_name` string — Code name of the place of service
    - `policies` object[] — Patient's insurance policies
      - `id` string — Policy identifier
      - `num` string — Policy number
      - `group_num` string — Insurance group number
      - `name` string — Policy name
      - `holder_first` string — Policy holder's first name
      - `holder_last` string — Policy holder's last name
      - `holder_relationship` string — Relationship between patient and policy holder
      - `claim_filing_indicator` string — Claim filing indicator code
      - `insurance_type_code` '12' | '13' | '14' | '15' | '16' | '41' | '42' | '43' | '47' — Insurance type code for Medicare secondary claims. Required when claim_filing_indicator is MA or MB and the policy is secondary.
      - `priority_type` string — Priority type of the insurance policy
      - `prior_authorization` string — Prior authorization reference number for the policy.
      - `insurance_plan` object — Insurance plan details
        - `payer_name` string, required — Name of the insurance payer
        - `payer_id` string, required — Identifier for the insurance payer
        - `name_and_id` string — Combined name and ID of the insurance plan
  - `billing_provider` object, required — Information about the billing provider
    - `name` string, required — Provider name
    - `npi` string, required — National Provider Identifier
    - `tax_id` string, required — Provider tax ID
    - `taxonomy_code` string — Provider taxonomy code
    - `location` object, required — Provider's address information
      - `city` string — City
      - `country` string — Country
      - `line1` string — Address line 1
      - `line2` string — Address line 2
      - `name` string — Location name
      - `state` string — State
      - `to_oneline` string — Single line address representation
      - `zip` string — ZIP/Postal code
      - `place_of_service` object — Place of service details
        - `code` string — Code of the place of service
        - `name` string — Name of the place of service
        - `code_name` string — Code name of the place of service
  - `rendering_provider` object, required — Information about the rendering provider
    - `id` string — Provider identifier
    - `first_name` string — Provider's first name
    - `last_name` string — Provider's last name
    - `name` string — Provider's full name
    - `npi` string, required — Provider's NPI
    - `taxonomy_code` string — Provider's taxonomy code
    - `gender` string — Provider's gender
    - `dob` string — Provider's date of birth
    - `location` object — Provider's address information
      - `city` string — City
      - `country` string — Country
      - `line1` string — Address line 1
      - `line2` string — Address line 2
      - `name` string — Location name
      - `state` string — State
      - `to_oneline` string — Single line address representation
      - `zip` string — ZIP/Postal code
      - `place_of_service` object — Place of service details
        - `code` string — Code of the place of service
        - `name` string — Name of the place of service
        - `code_name` string — Code name of the place of service
  - `referring_provider` object — Information about the referring provider.
    - `id` string — Provider identifier
    - `first_name` string — Provider's first name
    - `last_name` string — Provider's last name
    - `name` string — Provider's full name
    - `npi` string, required — Provider's NPI
    - `gender` string — Provider's gender
    - `dob` string — Provider's date of birth
  - `ordering_provider` object — Information about the ordering provider.
    - `id` string — Provider identifier
    - `first_name` string — Provider's first name
    - `last_name` string — Provider's last name
    - `name` string — Provider's full name
    - `npi` string, required — Provider's NPI
    - `taxonomy_code` string — Provider's taxonomy code
    - `gender` string — Provider's gender
    - `dob` string — Provider's date of birth
    - `location` object — Provider's address information
      - `city` string — City
      - `country` string — Country
      - `line1` string — Address line 1
      - `line2` string — Address line 2
      - `name` string — Location name
      - `state` string — State
      - `to_oneline` string — Single line address representation
      - `zip` string — ZIP/Postal code
      - `place_of_service` object — Place of service details
        - `code` string — Code of the place of service
        - `name` string — Name of the place of service
        - `code_name` string — Code name of the place of service
  - `service_location` object — Location of the service
    - `id` string — Location identifier. If provided, will be used to match the location.
    - `city` string — City
    - `country` string — Country
    - `line1` string — Address line 1. If id is not provided, this field will be used to match the location in conjunction with the name.
    - `line2` string — Address line 2
    - `name` string — Location name. If id is not provided, this field will be used to match the location in conjunction with the address.
    - `state` string — State
    - `to_oneline` string — Single line address representation
    - `zip` string — ZIP/Postal code
    - `place_of_service` object — Place of service details
      - `code` string — Code of the place of service
      - `name` string — Name of the place of service
      - `code_name` string — Code name of the place of service
  - `cpt_codes_cms1500s` object[], required — CPT codes associated with the claim
    - `fee` string — Billed amount for this service
    - `units` string — Number of units for this service
    - `mod1` string — Modifier 1
    - `mod2` string — Modifier 2
    - `mod3` string — Modifier 3
    - `mod4` string — Modifier 4
    - `ndc_information` object — Optional NDC drug identification for the service line. When present, all fields are required.
      - `ndc_code` string, required — National Drug Code for the service line
      - `ndc_quantity` string, required — Drug quantity for the NDC on this service line
      - `ndc_quantity_unit` 'F2' | 'GR' | 'ME' | 'ML' | 'UN', required — Unit of measure.
    - `cpt_code` object, required
      - `code` string, required — CPT code value
  - `icd_codes_cms1500s` object[], required — ICD diagnosis codes associated with the claim
    - `icd_code` object, required
      - `code` string, required — ICD code value
  - `claim_condition_codes` object[] — Claim condition codes
    - `code` string, required — Condition code value
  - `claim_additional_information` object[] — Additional information codes for the claim
    - `code` string, required — Additional information code
    - `text` string — Additional information text
  - `injury_cause_reasons` object — Information about injury cause and reasons. If all are false, omit this field.
    - `employment_related` boolean, required — Whether the injury is employment related
    - `auto_accident` boolean, required — Whether the injury is from an auto accident
    - `other` boolean, required — Whether the injury is from another cause
    - `state` string — State where the accident occurred
  - `patient_paid_amount` number — Amount paid by the patient
  - `clia_number` string — Clinical Laboratory Improvement Amendment (CLIA) number for CLIA-certified facilities performing CLIA-covered laboratory services.

## Response `200`

Claim created successfully

- OperationOutcome — A FHIR standard response format for operations
  - `resourceType` 'OperationOutcome', required — Type of resource
  - `id` string — Logical id of this artifact
  - `issue` object[], required — A list of issues with the operation
    - `severity` 'fatal' | 'error' | 'warning' | 'information', required — Severity of the issue
    - `code` 'invalid' | 'structure' | 'required' | 'value' | 'invariant' | 'security' | 'login' | 'unknown' | 'expired' | 'forbidden' | 'suppressed' | 'processing' | 'not-supported' | 'duplicate' | 'multiple-matches' | 'not-found' | 'deleted' | 'too-long' | 'code-invalid' | 'extension' | 'too-costly' | 'business-rule' | 'conflict' | 'transient' | 'lock-error' | 'no-store' | 'exception' | 'timeout' | 'incomplete' | 'throttled' | 'informational', required — Error or warning code
    - `diagnostics` string — Additional diagnostic information about the issue
    - `details` object
      - `text` string — Text description of the issue
      - `coding` object[] — Coding of the issue
    - `location` string[] — Locations in the resource where the issue occurred
    - `expression` string[] — FHIRPath of element(s) causing the issue

## Other responses

- `400` — Invalid request body or validation error
- `401` — Unauthorized access or invalid organization ID

---

[API](https://skmtc.net/cairhealth/apis/cair-health-apis.md) · [All operations](https://skmtc.net/cairhealth/apis/cair-health-apis/llms.txt) · [OpenAPI document](https://skmtc-service-staging.skmtc.workers.dev/v1/apis/cairhealth/cair-health-apis/revisions/dfc60069747b/schema)